Tag Archives: provider network management

Solving the health care risk challenge

Did you know that one-third of Americans’ health plan coverage will be part of a shared-risk program by 2020? In fact, more than 90 percent of health plans already include value-based reimbursement contract terms with their network providers. The transitioning market has created the Triple Aim, where quality of care, more affordable care and patient […]
Read More »

Designing an effective integrated clinical model

As the shift to risk-sharing and value-based models of care continues, physicians, hospitals and hospital based physician group must put greater focus on better coordination of care and outcomes. They must also be capable of taking on some level of clinical and financial risk. But how do we integrate these different aspects into a single […]
Read More »

Aligning network adequacy to meet greater expectations

With the passing of the Affordable Care Act (ACA) and the advent of the health insurance marketplace, network adequacy has come under greater scrutiny. Increased emphasis getting the right providers to consumers is leading health plans away from expansive networks to a narrow, more efficient network design that better serves member needs. Not lost in […]
Read More »

Innovative payment approach for successful value-based reimbursement models

As you see health care transitioning away from traditional fee-for-service payments and toward performance-based payments, value-based reimbursement (VBR) approaches are becoming popular options for health plans. Pay-for-performance contracts, patient-centered medical homes, bundled payments and accountable care organizations offer unique value creation while allowing payer organizations to work collaboratively with their provider partners. Payers are looking […]
Read More »